IMPACT OF DRGS ON PUBLIC HOME HEALTH NURSING SERVICES

美国医疗保健服务向预期付费的转变 各州已经扰乱了大部分现有的医疗保健系统。当前 关于诊断相关群体(DRGs)的研究几乎完全涉及 急诊护理环境。研究结果通常得出结论，医院 住院时间较短、健康状况较差的患者会出院 各州。可以预见的是，这样的变化将对 社区(院外)卫生保健系统。尽管如此，在 这一领域明显缺失。需要检查来自 社区视角是至关重要的。更改的早期文档记录 社区服务需求和随之而来的资源消耗 促进资源开发和分配方面的适当调整。 卫生服务适应新的患者群体至关重要 维护最佳社区健康。尤其是公共服务提供者， 必须迅速注意服务提供响应，因为他们几乎没有 或者无法控制需求。 这项拟议的研究将检查公共卫生部门住院后的住所。 两组(医疗保险和非医疗保险)健康患者的特征 在两个时间段(DRGs之前的一年和DRGs之后的一年)。 卫生部门将根据地区、面积、老年人口比例、 公共卫生护士与人口的比例，以及乡村。外地工作人员将 来自大约3000个卫生部门记录的代码数据。数据将 根据患者预后反映护理资源消耗情况， 护理数量、护理强度和结果。差异在于 这些指标将在小组之间和时间段之间进行分析。 分析将受控于乡村、老年人百分比和公共 保健护士/人口比率。还将研究地区差异。 拟议研究的结果将对以下方面产生重大影响 机构结构和职能的变化。例如，人员分配或 可根据以下方面的需求变化重新设计服务组合 护理资源的数量或强度。增长不尽如人意 结果也可以预示着需要的改变。如果美国经济大幅增长 每次访问的平均资源消耗被记录下来，它将带来 对历史成本基础提出质疑，历史成本基础被用来开发 未来的支付系统。

The move to prospective payment for health care services in the United States has disrupted much of the established health care system. Current research on Diagnosis RElated Groups (DRGs) deals almost exclusively with acute care settings. Study findings generally conclude that hospital patients are discharged after shorter lengths of stay and in less healthy states. Predictably, changes such as these will have an impact on the community (extra-hospital) health care system. Nonetheless, research in this area is conspicuously absent. The need for examining changes from a community perspective is critical. Early documentation of changes in community service demands and consequent resource consumption will facilitate appropriate adjustments in resource development and allocation. Health service adaptation to new patient populations is crucial to maintaining optimal community health. Public providers, in particular, must attent quickly to service provision responses since they have little or no control over demand. The proposed study will examine public health department post-hospital home health patient characteristics of two groups (Medicare and non-Medicare) during two time periods (one year before DRGs and one year after DRGs). Health departments will be selected based on region, area percent elderly, public health nurse to population ratio, and rurality. Field staff will code data from approximately 3000 health department records. The data will reflect nursing resource consumption as indicated by patient prognosis, quantity of nursing care, intensity of care and outcome. Differences in these indicators will be analyzed between groups and between time periods. Analyses will be controlled for rurality, percent elderly, and public health nurse/population ratio. Regional variation will also be examined. The findings of the proposed study will have significant implications for agency structural and functional changes. For example, staff allocation or service complement may be re-designed based on changes in demand for quantity or intensity of nursing resources. Increases in unsatisfactory outcomes can also signal needed changes. If significant increases in the average resource consumption per visit are documented, it will bring into question the historical cost base which has been used to develop the prospective payment system.